Hair loss

Hair loss is also called alopecia. It occurs because the cells of the hair follicles grow rapidly, which makes them sensitive to the effects of some cancer treatments.

Causes

Chemotherapy or radiation therapy can cause hair loss. Some hormonal and biological therapies can also make the hair thinner and dry.

Chemotherapy

Hair loss is a common side effect of chemotherapy, but not all drugs cause hair loss. In most cases, hair loss is temporary. The amount of hair loss and how long it takes to grow back depends on:

the type of drug

the dose of drug

length of treatment

personal factors

Some chemotherapy drugs that can cause hair loss include:

cisplatin (Platinol AQ)

cyclophosphamide (Cytoxan, Procytox)

cytarabine (Cytosar, Ara-C)

dactinomycin (Cosmegan, actinomycin-D)

daunorubicin (Cerubidine, Daunomycin)

docetaxel (Taxotere)

doxorubicin (Adriamycin)

etoposide (Vepesid)

idarubicin (Idamycin)

ifosfamide (Ifex)

irinotecan (Camptosar)

mechlorethamine (nitrogen mustard, Mustargen)

methotrexate

paclitaxel (Taxol)

topotecan (Hycamtin)

trimetrexate

vinblastine (Velbe)

vincristine (Oncovin)

Radiation therapy

Radiation therapy can cause hair loss in the area where the radiation was given. The amount of hair loss and whether it will grow back depends on the dose of radiation given. Permanent hair loss is more common when higher doses of radiation are given. Radiation therapy to the head often causes permanent hair loss.

Symptoms

Symptoms of hair loss can vary depending on their cause and other factors. Hair may become thinner or it may fall out entirely. It usually falls out in clumps. Remaining hair may become dull or dry. Hair loss is not usually accompanied by any other symptoms, although some people have scalp discomfort or tenderness 1–2 days before and during hair shedding.

Hair loss can occur gradually or quite quickly. It often begins 2–3 weeks after chemotherapy or radiation therapy starts.

With radiation therapy, hair loss occurs only in the area treated with radiation. With chemotherapy, hair loss can occur on all parts of the body:

head – the scalp may also feel tender

face – some or all of the eyelashes and eyebrows may fall out

body – some or all of the pubic, chest and underarm hair may fall out

Loss of facial and body hair is usually less severe because hair grows less actively in these areas than on the scalp.

Managing hair loss

Your healthcare team can suggest ways to help you manage and cope with hair loss, including the following.

Be gentle with your hair. Wash the hair on your head less frequently once it starts to fall out. Use a mild protein shampoo twice a week and massage the scalp. A protein conditioner can be used to help add body to fine or limp hair. Use a soft hair brush and a hair dryer set on low heat or let hair dry naturally. Pat the hair dry rather than rub it. Avoid curling irons, straightening irons and hot rollers. Avoid perms, hair colour, bleach, peroxide, ammonia and lacquer during treatment. These products can contain chemicals that can irritate the scalp and damage the hair. Wear a soft cloth cap at night to catch hairs as they fall out. Use a satin pillow case as it is softer and smoother than other materials.

For long or medium-length hair, get a shorter cut to make hair look fuller and thicker. It might also help to make hair loss less dramatic. Try wearing a scarf, turban or hat if feeling sensitive about hair loss. This also helps keep the head warm. Consider buying a wig or toupee. Try to select if before your hair falls out so that it is easier to match to the hair colour and style. Check with provincial and private health insurance about coverage for wig purchases.

Protect your scalp when you go outside. Wear a wide-brimmed hat or scarf, or use sunscreen on the scalp. Wear sunglasses to protect your eyelashes.

You can use make-up when eyebrows or eyelashes thin or fall out because of treatment. A Look Good Feel Better program volunteer can suggest make-up techniques, such as using eyeliner, that can help fill in or recreate eyebrows and eyelashes.

Brush and wash away hair that is falling out. Gently wash loose hair from arms, underarms and pubic areas. Men should also wash hair from the chest and face.

Hair regrowth

Hair usually grows back once treatments are completed. The time for this can vary. Many people find that their hair starts to grow back before their chemotherapy treatment is finished or very soon afterwards (usually 4–6 weeks). With radiation therapy, smaller doses usually result in temporary hair loss in the treated area. Regrowth usually starts 3–6 months after radiation therapy is completed.

Some people find that the hair that grows back is a different texture, colour and type. The new hair may be finer or coarser, lighter or darker, or straight or curly. These changes are usually temporary. It may take one year or longer before hair completely grows back and returns to its original state.

When hair regrows, it may not be as strong as it was before. Weak hair is more likely to break. Products like perms, hair dyes or chemical hair straighteners should not be used until hair returns to normal. This may take as long as 6 months or more after treatment. Chemically treating new hair is not recommended until after 3 haircuts or trims. Talk to your healthcare team about when it is okay to use these products again.

Special considerations for children

Hair loss can be very distressing because it is a very visible side effect. Younger children may not be affected as much as school-age children and teenagers. The following may help a child prepare for, and cope with, hair loss.

Understand that hair loss may be very difficult for both you and your child. Know that a child may feel differently than a parent about the hair loss.

If the child is interested, it may help to cut their hair short or choose a wig and wear it before hair loss begins. Taking these steps can help ease the transition. A wig may need some styling, trimming and other adjustments by a professional to fit and look good.

Take the child’s picture with their hair as it is usually worn. If the child decides to wear a wig, the hair stylist can use the picture to help shape the wig. Keep a snippet of the child’s hair to help match the colour and texture.

Offer the child a gift to decorate or comfort the body, such as a funky hat, lipstick, nail polish, body lotion or funny T-shirt. Select several scarves and hats and wear them before and after hair loss begins. Wear scarves tied in interesting styles.

Let the child’s teacher know that the child will be losing hair so that the teacher can speak to the class ahead of time to minimize the reaction when the child returns to school.